Early postoperative complications after transverse colostomy closure,a retrospective study

BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer(CRC)surgery and perforation or to relieve intestinal obstruction.AIM To analyze the complications after transverse colostomy closure.METHODS Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical center.The differences between the complication group and the no complication group were compared.Logistic regression analyses were conducted to find independent factors for overall complications or incision infection.RESULTS A total of 102 patients who underwent transverse colostomy closure were enrolled in the current study.Seventy(68.6%)patients underwent transverse colostomy because of CRC related causes.Postoperative complications occurred in 30(29.4%)patients and the most frequent complication occurring after transverse colostomy closure was incision infection(46.7%).The complication group had longer hospital stays(P<0.01).However,no potential risk factors were identified for overall complications and incision infection.CONCLUSION The most frequent complication occurring after transverse colostomy closure surgery in our center was incision infection.The operation time,interval from transverse colostomy to reversal,and method of anastomosis might have no impact on the postoperative complications.Surgeons should pay more attention to aseptic techniques.

Application of Pelvic Peritoneum Closure Combined with Extraperitoneal Colostomy in Laparoscopic Surgery for Low Rectal Cancer

Background:In the treatment of colorectal cancer,laparoscopic surgery has seen a significant amount of success.Reducing the risk of postoperative complications and improving patients’quality of life can be accomplished by appropriately employing pelvic peritoneal repair and sigmoid colostomy when appropriate.Objective:To compare fusion closure of pelvic peritoneum combined with extraperitoneal colostomy with non-closure of pelvic peritoneum combined with intraperitoneal colostomy in patients with low rectal cancer who had permanent colostomy.Methods:Low rectal cancer patients admitted to Hengshui People’s Hospital for permanent colostomy were evaluated.The participants were divided into two groups:an observation and a control group.All 30 cases in the observation group underwent pelvic peritoneum closure and extraperitoneal colostomy,while the other 30 cases in the control group underwent intraperitoneal colostomy.The C-reactive protein(CRP)levels of the participants in both groups were evaluated for 6 months to 2 years(24 h before,24 h after,48 h after,96 h after surgery).Results:Comparing the colostomy operative time,time to first passage of flatus postoperatively,time to first defecation postoperatively,length of hospital stay,laboratory indicators,stoma-related complications,colostomy function,etc.,the colostomy operative time significantly differed between the two groups(P<0.05);the observation group did considerably better than the control group in terms of stoma-related complications and bowel movement control 6 months after surgery(P<0.05);and although serum CRP levels increased in both groups 48 h after surgery,the difference was significant(P<0.05).Conclusion:Extraperitoneal colostomy can improve the quality of life of patients with permanent stoma and reduce the occurrence of stoma-related complications.Thus,this technique is worthy of promotion in clinical practice.

Effect of internet multiple linkage mode-based extended care combined with in-hospital comfort care on colorectal cancer patients undergoing colostomy

BACKGROUND Patients with colorectal cancer may need postoperative nursing to improve prognosis,and conventional nursing is not effective.Clinical research is needed to explore nursing methods that can more effectively improve postoperative conditions on colorectal cancer patients undergoing colostomy.AIM To explore the effect of internet multiple linkage mode-based extended care combined with in-hospital comfort care on colorectal cancer patients undergoing colostomy.METHODS Data from 187 patients with colostomy treated in our hospital from May 2019 to March 2022 were collected and divided into three groups,A(n=62),B(n=62)and C(n=63),according to different intervention methods.Group A received internet multiple linkage mode-based extended care combined with in-hospital comfort care.Group B received internet multiple linkage mode-based extended care.Group C received usual care intervention.Complications were compared among the three groups.The stoma self-efficacy scale,Hamilton Anxiety Scale,RESULTS The complication rate of group A,B and C(16.13%,20.97%and 60.32%,respectively)was significantly different(all P<0.05).The incidence of complications in groups A and B was lower than that in group C,and there was no significant difference between groups A and B(P>0.05).After intervention,the scores of ostomy care,social contact,diet choice,confidence in maintaining vitality,confidence in self-care of ostomy,confidence in sexual life,confidence in sexual satisfaction and confidence in physical labor in the three groups were all higher than before intervention,and the scores of groups A and B were higher than those of group C,with statistical significance(P<0.05).The Hamilton Anxiety Scale and Hamilton Depression Scale scores of the three groups after intervention were lower than those before intervention.The scores of groups A and B were lower than those of group C,and the score of group A was lower than that of group B,all with statistical significance(all P<0.05).There was a statist-ically significant difference in cancer-induced fatigue among the three groups(P<0.05).After intervention,the scores of physical health,psychological health,social health and mental health of the three groups were lower than before the intervention.The scores of group A and B were lower than that of group C;and the score of group A was lower than that of group B,all with statistical significance(all P<0.05).CONCLUSION Internet multiple linkage mode-based extended care combined with in-hospital comfort care can effectively improve self-efficacy,bad mood,cancer-related fatigue and life quality of colorectal cancer patients undergoing colostomy.

Colostomy is a simple and effective procedure for severe chronic radiation proctitis

AIM: To assess the efficacy and safety of diverting colostomy in treating severe hemorrhagic chronic radiation proctitis(CRP). METHODS: Patients with severe hemorrhagic CRP who were admitted from 2008 to 2014 were enrolled into this study. All CRP patients were diagnosed by a combination of pelvic radiation history, clinical rectal bleeding, and endoscopic findings. Inclusion criteria were CRP patients with refractory bleeding with moderate to severe anemia with a hemoglobin level < 90 g/L. The study group included patients who were treated by diverting colostomy, while the control group included patients who received conservative treatment. The remission of bleeding was defined as complete cessation or only occasional bleeding that needed no further treatment. The primary outcome was bleeding remission at 6 mo after treatment. Quality of life beforetreatment and at follow-up was evaluated according to EORTC QLQ C30. Severe CRP complications were recorded during follow-up.RESULTS: Forty-seven consecutive patients were enrolled, including 22 in the colostomy group and 27 in the conservative treatment group. When compared to conservative treatment, colostomy obtained a higher rate of bleeding remission(94% vs 12%), especially in control of transfusion-dependent bleeding(100% vs 0%), and offered a better control of refractory perianal pain(100% vs 0%), and a lower score of bleeding(P < 0.001) at 6 mo after treatment. At 1 year after treatment, colostomy achieved better remission of both moderate bleeding(100% vs 21.5%, P = 0.002) and severe bleeding(100% vs 0%, P < 0.001), obtained a lower score of bleeding(0.8 vs 2.0, P < 0.001), and achieved obvious elevated hemoglobin levels(P = 0.003), when compared to the conservative treatment group. The quality of life dramatically improved after colostomy, which included global health, function, and symptoms, but it was not improved in the control group. Pathological evaluation after colostomy found diffused chronic inflammation cells, and massive fibrosis collagen depositions under the rectal wall, which revealed potential fibrosis formation. CONCLUSION: Diverting colostomy is a simple, effective and safe procedure for severe hemorrhagic CRP. Colostomy can improve quality of life and reduce serious complications secondary to radiotherapy.

Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: A case report and review of the literature

Percutaneous endoscopic colostomy （PEC） is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal pseudo-obstruction evolving since 8 years was readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient＇s quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications.

Subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy for the treatment of slow transit constipation in an aged population:A retrospective control study

AIM To compare the efficacy,improved quality of life,and prognosis in patients undergoing either subtotal colonic bypass with antiperistaltic cecoproctostomy(SCBAC) or subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy(SCBCAC) for the treatment of slow transit constipation.METHODS Between October 2010 and October 2014,aged patients with slow transit constipation who were hospitalized and underwent laparoscopic surgery in our institute weredivided into two groups: the bypass group,15 patients underwent SCBAC,and the bypass plus colostomy group,14 patients underwent SCBCAC. The following preoperative and postoperative clinical data were collected: gender,age,body mass index,operative time,first flatus time,length of hospital stay,bowel movements(BMs),Wexner fecal incontinence scale,Wexner constipation scale(WCS),gastrointestinal quality of life index(GIQLI),numerical rating scale for pain intensity(NRS),abdominal bloating score(ABS),and ClavienDindo classification of surgical complications(CD) before surgery and at 3,6,12,and 24 mo after surgery.RESULTS All patients successfully underwent laparoscopic surgery without open surgery conversion or surgeryrelated death. The operative time and blood loss were significantly less in the bypass group than in the bypass plus colostomy group(P = 0.007). No significant differences were observed in first flatus time,length of hospital stay,or complications with CD > 1 between the two groups. No patients had fecal incontinence after surgery. At 3,6,and 12 mo after surgery,the number of BMs was significantly less in the bypass plus colostomy group than in the bypass group. The parameters at 3,6,12,and 24 mo after surgery in both groups significantly improved compared with the preoperative conditions(P < 0.05),except NRS at 3,6 mo after surgery in both groups,ABS at 12,24 mo after surgery and NRS at 12,24 mo after surgery in the bypass group. WCS,GIQLI,NRS,and ABS significantly improved in the bypass plus colostomy group compared with the bypass group at 3,6,12,and 24 mo after surgery(P < 0.05) except WCS,NRS at 3,6 mo after surgery and ABS at 3 mo after surgery. At 1 year after surgery,a barium enema examination showed that the emptying time was significantly better in the bypass plus colostomy group than in the bypass group(P = 0.007).CONCLUSION Laparoscopic SCBCAC is an effective and safe procedure for the treatment of slow transit constipation in an aged population and can significantly improve the prognosis. Its clinical efficacy is more favorable compared with that of SCBAC. Laparoscopic SCBCAC is a better procedure for the treatment of slow transit constipation in an aged population.

The Application of Multimedia Messaging Services via Mobile Phones to Support Outpatients:Home Nursing Guidance for Pediatric Intestinal Colostomy Complications

Objective: To present a model of extended home nursing support provided through WeChat for pediatric colostomy patients between the first and second surgery to support parents and to assist them in nursing possible complications at home, to reduce colostomy complications caused by improper care, to improve the quality of life of patients at home and to ensure the success of the recovery and second surgery. Methods: A combination of relevant clinical information, health care guidelines, and training as well as the establishment of a specific monitoring protocol was provided to the parents during the patient’ s first hospitalization. A support system for nursing the colostomy was established with regular follow-up via WeChat after the patient’ s first discharge from the hospital using a predetermined protocol. During the 3 to 6 months of home care in-between the colostomy operations, the charge nurse initiated the phone follow-up and provided specific, individual guidance and feedback. If necessary, extended serv-ice at predetermined intervals was provided in the 1st week, the 1st month, the 2nd month and the 3rd month. Results: Extended assistance for the home care of patients with pediatric colostomy complications im-proved the quality of life of the patients and caregivers and was accepted by all parties involved upon in-troduction. The assistance provided support for the parents at all hours, efficiently reduced the level of complications for this type of patient and facilitated fast referrals to hospital care in cases of emergen-cies. Furthermore it paved the way to successful second stage surgeries, provided direct feedback to the charge nurse and improved the work satisfaction and sense of achievement of the nurses involved. Conclusions: All 80 cases supported by WeChat successfully underwent two-stage pediatric colostomy operations. The response of the parents and the medical staff involved was very positive. This method is easy to use, economical to operate and could be applied generally to support home care.

Diverting colostomy is an effective and reversible option for severe hemorrhagic radiation proctopathy

BACKGROUND Severe chronic radiation proctopathy(CRP) is difficult to treat.AIM To evaluate the efficacy of colostomy and stoma reversal for CRP.METHODS To assess the efficacy of colostomy in CRP,patients with severe hemorrhagic CRP who underwent colostomy or conservative treatment were enrolled.Patients with tumor recurrence,rectal-vaginal fistula or other types of rectal fistulas,or who were lost to follow-up were excluded.Rectal bleeding,hemoglobin(Hb),endoscopic features,endo-ultrasound,rectal manometry,and magnetic resonance imaging findings were recorded.Quality of life before stoma and after closure reversal was scored with questionnaires.Anorectal functions were assessed using the CRP symptom scale,which contains the following items:Watery stool,urgency,perianal pain,tenesmus,rectal bleeding,and fecal/gas incontinence.RESULTS A total of 738 continual CRP patients were screened.After exclusion,14 patients in the colostomy group and 25 in the conservative group were included in the final analysis.Preoperative Hb was only 63 g/L ± 17.8 g/L in the colostomy group compared to 88.2 g/L ± 19.3 g/L(P < 0.001) in the conservative group.All14 patients in the former group achieved complete remission of bleeding,and the colostomy was successfully reversed in 13 of 14(93%),excepting one very old patient.The median duration of stoma was 16(range:9-53) mo.The Hb level increased gradually from 75 g/L at 3 mo,99 g/L at 6 mo,and 107 g/L at 9 mo to111 g/L at 1 year and 117 g/L at 2 years after the stoma,but no bleeding cessation or significant increase in Hb levels was observed in the conservative group.Endoscopic telangiectasia and bleeding were greatly improved.Endoultrasound showed decreased vascularity,and magnetic resonance imaging revealed an increasing presarcal space and thickened rectal wall.Anorectal functions and quality of life were significantly improved after stoma reversal,when compared to those before stoma creation.CONCLUSION Diverting colostomy is a very effective method in the remission of refractory hemorrhagic CRP.Stoma can be reversed,and anorectal functions can be recovered after reversal.

Treatment of recurrent sigmoid volvulus in Parkinson's disease by percutaneous endoscopic colostomy

The exact aetiology of sigmoid volvulus in Parkinson's disease(PD) remains unclear.A multiplicity of factors may give rise to decreased gastrointestinal function in PD patients.Early recognition and treatment of constipation in PD patients may alter complications like sigmoid volvulus.Treatment of sigmoid volvulus in PD patients does not differ from other patients and involves endoscopic detorsion.If feasible,secondary sigmoidal resection should be performed.However,if the expected surgical morbidity and mortality is unacceptably high or if the patient refuses surgery,percutaneous endoscopic colostomy(PEC) should be considered.We describe an elderly PD patient who presented with sigmoid volvulus.She was treated conservatively with endoscopic detorsion.Surgery was consistently refused by the patient.After recurrence of the sigmoid volvulus a PEC was placed.

Delayed ischemic gangrene change of distal limb despite optimal decompressed colostomy constructed in obstructedsigmoid colon cancer:A case report

Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently.

Correlation between acceptance of disability and social relational quality in patients with colostomy

Purpose:To investigate the correlation between acceptance of disability and the quality of social relations of patients with colostomies.Methods:A total of 111 patients with permanent colostomies were recruited by convenience sampling.They were asked to complete a general information questionnaire and assessed according to the Acceptance of Disability Scale and Social Relational Quality Scale.Results:Overall,the patients’acceptance of disability was moderate.The total score and factor scores of acceptance of disability were significantly correlated with the total score of social relational quality and the factor scores of family commitment and friendship(p<0.05).Conclusion:There is a positive correlation between acceptance of disability and social relational quality in patients with colostomy.These results will help improve patients’social relational quality of life and provide psychological intervention to promote their acceptance of disability.

Exteriorized colon anastomosis for unprepared bowel: An alternative to routine colostomy

AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel. METHODS: The cohort is composed of 103 patients, of these, 86 patients presented as emergencies (self- inflected and iatrogenic colon injuries, stab wounds and blast injury of the colon, volvulus sigmoid, obstructing left colon cancer, and strangulated ventral hernia). Another 17 patients were managed electively for other colon pathologies. During laparotomy, the involved segment was resected and the two ends of the colon were brought out via a separate colostomy wound. One layer of interrupted 3/0 silk was used for colon anastomosis. The exteriorized segment was immediately covered with a colostomy bag. Between the 5th and 7th postoperative day, the colon was easily dropped into the peritoneal cavity. The defect in the abdominal wall was closed with interrupted nonabsorbable suture. The skin was left open for secondary closure. RESULTS: The mean hospital stay (± SD) was 11.5 ± 2.6 d (8-20 d). The exteriorized colon was successfully dropped back into the peritoneal cavity in all patients except two. One developed a leak from oesophago- jejunostomy and from the exteriorized colon. She subsequently died of sepsis and multiple organ failure (MOF). In a second patient the colon proximal to the exteriorized anastomosis prolapsed and developed severe serositis, an elective ileo-colic anastomosis (to the left colon) was successfully performed. CONCLUSION: Exteriorized colon anastomosis is simple, avoids the inconvenience of colostomy and can be an alternative to routine colostomy. It is suitable where colostomy is socially unacceptable or the facilities and care is not available.

Loop Ileostomy and Colostomy—A Comparison between Supporting Plastic Rods and Epicutaneous or Subcutaneous Silicon Drains

Purpose: Beside the conventional plastic rods, different techniques and materials have been proposed in the last years to prevent the loop from retraction into the abdominal cavity. The aim of this retrospective comparative study was to assess three different techniques of loop support. Methods: The study included 65 pa- tients who had loop ileostomy or colostomy formed. Depending on the decision of the operating surgeon, one of three techniques was chosen to fixate the stoma loop: an epicutaneous plastic rod (group 1, n = 14), an epicutaneous suture-fixated silicone drain (group 2, n = 27), or a subcutaneous silicone drain (group 3, n = 24). Results: The majority of patients (85%) received loop ileostomy. Pain intensity was significantly (p = 0.0014) different among the three groups. A total of 19 patients (30%) suffered a complication. There was a tendency towards less complications if the stoma was secured by a silicone drain with epicutaneous fixation. Comfort with stoma care was significantly different, with group 3 experiencing the best results. Conclusions: Using a subcutaneously tunnelled silicon drain as a stoma bridge results in less complications, less pain and higher satisfaction as compared to the conventional plastic rod. Conventional plastic rods should be avoided.

Risk factors for parastomal hernia in patients with colostomy:a scope overview

Objective:To investigate the risk factors of parastomal hernia in patients with a colostomy.Methods:The related studies published in Embase,PubMed,CNKI,and other databases were searched.The search time limit was from the establishment of the database to March 2020.After the literature screening,data extraction and cross-checking were carried out independently by two researchers,the qualitative research method was used to summarize.Results:After screening,6 articles were included.The results of qualitative analysis showed that a total of 10 risk factors of parastomal hernia were concluded which could be classified into personal and colostomy factors.Conclusion:The current evidence showed that 10 risk factors such as age,Body Mass Index and colostomy were related to the occurrence of parastomal hernia in patients with a colostomy.Limited by the type and quantity of research,the above conclusions need to be verified by more high-quality research.

Reinforced tissue matrix to strengthen the abdominal wall following reversal of temporary ostomies or to treat incisional hernias

BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence.Biologic meshes have also been used to enhance healing,particularly in contaminated conditions.Reinforced tissue matrices(R-TMs),which include a biologic scaffold of native extracellular matrix and a syn-thetic component for added strength/durability,are designed to take advantage of aspects of both synthetic and biologic materials.To date,RTMs have not been reported to reinforce the abdominal wall following stoma reversal.METHODS Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma.Following hernia repair and proximal stoma closure,RTM(OviTex®1S permanent or OviTex®LPR)was placed to reinforce the abdominal wall using a laparoscopic,robotic,or open surgical approach.Post-operative follow-up was performed at 1 month and 1 year.Hernia recurrence was determined by physical examination and,when necessary,via computed tomo-graphy scan.Secondary endpoints included length of hospital stay,time to return to work,and hospital readmissions.Evaluated complications of the wound/repair site included presence of surgical site infection,seroma,hematoma,wound dehiscence,or fistula formation.RESULTS The observational study cohort included 16 male and 12 female patients with average age of 58.5 years±16.3 years and average body mass index of 26.2 kg/m^(2)±4.1 kg/m^(2).Patients presented with a parastomal hernia(75.0%),in-cisional hernia(14.3%),or combined parastomal/incisional hernia(10.7%).Using a laparoscopic(53.6%),robotic(35.7%),or open(10.7%)technique,RTMs(OviTex®LPR:82.1%,OviTex®1S:17.9%)were placed using sublay(82.1%)or intraperitoneal onlay(IPOM;17.9%)mesh positioning.At 1-month and 1-year follow-ups,there were no hernia recurrences(0%).Average hospital stays were 2.1 d±1.2 d and return to work occurred at 8.3 post-operative days±3.0 post-operative days.Three patients(10.7%)were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues.Fistula and mesh infection were observed in two patients each(7.1%),leading to partial mesh removal in one patient(3.6%).There were no complications between 1 month and 1 year(0%).CONCLUSION RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal,with no hernia recurrences and favorable outcomes after 1-month and 1-year.

Patients after colostomy： relationship between quality of life and acceptance of disability and social support

Background The aim of this research was to explore quality of life （QOL） and acceptance of disability and social support of colostomy patients as well as the relationship between these factors. Methods A descriptive, correlational study was conducted using four scales： the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire （EORTC QLQ-C30） and European Organization for Research and Treatment of Cancer Colorectal Cancer-Specific Quality of Life Questionnaire （EORTC QLQ-CR38） scales, the Acceptance of Disability Scale （ADS）, and the Social Relational Quality Scale （SRQS）. A convenience sample of 111 colostomy patients from four hospitals in Guangzhou who underwent colostomy operation at least one month prior to the study and who visited the stoma clinic or association from August 2011 to February 2012 was evaluated for inclusion in the study. All statistical analyses were performed using SPSS 17.0 software （SPSS Inc., Chicago, IL, USA）.

Current state of laparoscopic parastomal hernia repair:A meta-analysis

AIM:To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.METHODS:A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords:stoma repair,laparoscopic,parastomal,and hernia.Case reports,studies with less than 5 patients,and articles not written in English were excluded.Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine.Two authors reviewed and analyzed each study.If there was any discrepancy between scores,the study in question was referred to another author.A meta-analysis was performed using both random and fixed-effect models.Publication bias was evaluated using Begg's funnel plot and Egger's regression test.The primary outcome analyzed was recurrence of parastomal hernia.Secondary outcomes were mesh infection,surgical site infection,obstruction requiring reoperation,death,and other complications.Studies were grouped by operative technique where indicated.Except for recurrence,most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach.RESULTS:Fifteen articles with a total of 469 patients were deemed eligible for review.Most postoperative morbidities were reported for the overall cohort,and not by approach.The overall postoperative morbidity rate was 1.8%(95%CI:0.8-3.2),and there was no difference between techniques.The most common postoperative complication was surgical site infection,which was seen in 3.8%(95%CI:2.3-5.7).Infected mesh was observed in 1.7%(95%CI:0.7-3.1),and obstruction requiring reoperation also occurred in 1.7%(95%CI:0.7-3.0).Other complications such as ileus,pneumonia,or urinary tract infection were noted in16.6%(95%CI:11.9-22.1).Eighty-one recurrences were reported overall for a recurrence rate of 17.4%(95%CI:9.5-26.9).The recurrence rate was 10.2%(95%CI:3.9-19.0) for the modified laparoscopic Sugarbaker approach,whereas the recurrence rate was27.9%(95%CI:12.3-46.9) for the keyhole approach.There were no intraoperative mortalities reported and six mortalities during the postoperative course.CONCLUSION:Laparoscopic intraperitoneal mesh repair is safe and effective for treating parastomal hernia.A modified Sugarbaker approach appears to provide the best outcomes.

Two-stage resection for malignant colonic obstructions:The timing of early resection and possible predictive factors

AIM:To study potential predictive factors for early radical resection in two-stage resection for left malignant colonic obstruction.METHODS:Thirty-eight cases of left-sided obstructive colon cancer undergoing two-stage operations were reviewed between January 1998 and August 2008.Patients were classified into two groups(n = 19 each):early radical resection(interval ≤ 10 d) and late radical resection(interval > 10 d).Baseline demographics,post-diversion outcome,perioperative data,tumor characteristics,outcome and complications were analyzed.RESULTS:The baseline demographics revealed no differences except for less pre-diversion sepsis in the early group(P < 0.001) and more obstruction days in the late group(P = 0.009).The mean intervals of early and late radical resections were 7.9 ± 1.3 d and 17.8 ± 5.5 d,respectively(P < 0.001).After diversion,the presence of bowel sounds,flatus,removal of the nasogastric tube and the resumption of oral feeding occurred earlier in the early group.The operation time and duration of hospital stay were both significant reduced in the early group.Complication rates did not differ between groups.CONCLUSION:The earlier recovery of bowel function seems to be predictive of early radical resection.In contrast,pre-diversion sepsis and more obstruction days were predictive of delayed radical resection.

Congenital H-type anovestibuler fistula

The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vulvar abscess. A 40-day-old girl presented symptoms after her parents noted the presence of stool at the vestibulum. On the physical examination, anus was in normal location and size, and had normal sphincter tone. A vestibuler opening was seen in the midline just below of the hymen. A fistulous communication was found between the vestibuler opening and the anus, just above the dentate line. There was a vulvar abscess which had a left lateral vulvar drainage opening 15 mm left lateral to the perineum. After the management of local inflammation and abscess, the patient was operated for primary repair of the fistula. A protective colostomy wasn′t performed prior the operation. A profuse diarrhea started after 5 hours of postoperation. After the diarrhea, a recurrent fistula was occurred on the second postoperative day. A divided sigmoid colostomy was performed. 2 months later, and anterior sagital anorectoplasty was reconstructed and colostomy was closed 1 month later. Various surgical techniques with or without protective colostomy have been described for double termination repair. But there is no consensus regarding surgical management of double termination.

The development status of specialized nursing in ostomy care both in China and abroad

The status of ostomy-specialized nurses＇ training and the specialized care for patients with permanent colostomy both in China and abroad are analyzed. Based on features and characteristics of the development of ostomy care outside China, problems in China＇s ostomy care are discussed to promote the sustainable development of this type of care.